William Humphrey was 47 years old when he had a seizure at work. After his initial evaluation in the ER, an MRI was obtained. This revealed he had two fairly large circular cystic masses in his left frontal lobe, very near his speech area.
Initially I thought they might be a spread of cancer from somewhere else in his body. And so, I ordered additional CT scans to see if a cancerous growth was lurking unnoticed. But these were negative.
They did not have the appearance of a primary brain tumor, so I considered that they might represent an infection. This seemed possible since Billy had recently been treated for a sinus infection.
And so, after discussing this with he and his wife Donna, I decided to take him to surgery to find out what they were and to remove them completely if I could.
As I exposed and biopsied the larger of the two masses, the appearance was all too familiar. It looked like a malignant astrocytoma. I initially biopsied the edge of the tumor and then at a point deeper knowing this would give the pathologist a greater chance of making an accurate diagnosis.
As I waited for the pathologist to call I proceeded to remove the larger of the two masses, certain it was brain cancer.
At this point, the pathologist, Charlie called in to the OR… ‘The first specimen from the edge of the tumor doesn’t have any brain tissue in it, and there is no signs of infection either’, he said.
A moment later he called back and said, ‘The second, deeper biopsy contains only some gliosis (or brain scar tissue), but no tumor’.
I was stunned. So, I biopsied another area of the ‘tumor’. ‘Negative’, The pathologist reported. At this point I used the intraoperative ultrasound to localize the second, smaller cyst and biopsied it. Again it had the appearance under the microscope, which I had seen a thousand times before. And again, the voice on the intercom in the OR reported, ‘negative for tumor’!
At this point it was hard to justify in my mind resecting the second ‘tumor’ since the back edge of it was right up against the speech area of Billy’s brain.
I stood there in silence, wondering if I had done the right thing. Since there was some blood within these masses, maybe they just represented resolving areas of benign hemorrhages of the brain, which can occur, sometimes for no reason.
As I voiced aloud that I had not done anything for Billy, the anesthesiologist snapped back at me. ‘ What do you mean you didn’t do anything for him? You are going to give him and his wife the best news they could have hoped for’…. I had to agree.
When I walked into the surgical waiting room, Donna and the rest of the family immediately got up out of their chairs to meet me half way. When I told her there was no tumor, she looked as shocked as I had been.
Actually she had a somewhat twisted and quizzical look on her face, as though I might be playing a very sick joke on her. ‘No’, I said as if reading her mind. ‘All the biopsies I sent to the pathologist were negative’. I then proceeded to tell her what had transpired.
I told them how I removed the larger of the two lesions, but since the biopsies were negative I decided not to risk attempting to remove the second. Donna quickly said, pointing to her father-in-law, ‘You had been praying that the tumor would disappear’!
They were all grateful, of course, but still in a state of shock. When I returned to the waiting room to let them know Billy was awake and perfectly fine, Donna remarked, ‘I saw that cross around your neck and know that you are a believer…and a miracle just happened tonight’. I nodded, though somewhat doubtful, I have to admit, and turned to return to the OR.
On Tuesday of the following week, I called Chris, one of the pathologists. He informed me that he had just been handed the permanent sections and he would ‘call me back in 10.’
When my cell phone rang 10 minutes later I answered and heard Chris’ voice on the other end. ‘Hal’, he said, and as he paused I knew what he was about to tell me was not good news. ‘I’ve looked at the most recent slides and on specimen #3, I see what looks like at least a Grade III malignant astrocytoma
I felt as though I had just been punched in the gut and had the wind knocked out of me. ‘But, I’m not 100% sure, he said ‘so I want to send the case out for a second opinion’.
That afternoon as I walked into the ICU, Billy looked great and said, ‘Thanks for operating on my brain and I’m ready to go home’ I told he and Donna the pathologist had looked at the permanent slides but still was uncertain so he wanted to send them out for a second opinion.
Billy remained up beat but Donna looked at me, not convinced, and said, ‘Should we be concerned?’ I’m sure I would make a lousy poker player, because all I could muster was, ‘Well no news is good news”.
As I left the ICU the radiologist, Yair called me and said he and Chris were going over the case and would I mind coming by as well.
As I sat looking at the MRI, I kept thinking, ‘I’m going to have to take that young guy back to the OR to remove that second tumor and I’ll probably damage his speech center in the process.
I pointed out to Yair and Chris where I had taken my biopsies, and then drifted off to the thoughts in my brain not really paying attention, as Yair was going on about how the characteristics of the tumor really did not look like a malignant astrocytoma.
In my other ear Chris was reiterating the pathology findings, only partly speaking to me, and more just talking aloud to himself.
I then blurted out, somewhat angrily, ‘OK so what do I do?’ Of course I knew I would have to be the one to decide.
As I drove home that evening, it occurred to me that if I ever needed to pray for a patient, it was for Billy. That either God would cure him or if I had to re-operate on him, God would guide my hands remove the tumor completely without complication.
That night I thought about another patient, Dennis Parker, whom I had operated on and how his blindness was inexplicably cured. I remembered how very limited my abilities were and that it was God who succeeded where I had failed.
Once again, I knew any miracle that might happen in Billy’s case would not come from me. So I got down on my knees and prayed some more.
Later that week, I received the consultant’s interpretation. Billy had an astrocytoma, no less than a Grade 3 out of 4. Since it was Thursday and there wouldn’t be anything I could do until the following week, I decided to wait until Monday to call Donna and Billy.
On Monday I called and spoke to Donna. I informed her of the results and that we should re-operate and aggressively remove what tumor remained. She asked, ‘When should we do this?’ I replied, ‘It might as well be tomorrow.” She agreed.
Billy was readmitted that day and I ordered a follow-up MRI. That evening I reviewed his scan and discovered the tumor had already begun to spread. In fact, its appearance now was more aggressive looking than it was initially.
My former partner, Kevin and I used to say that if you operated on a malignant astrocytoma, you had better take it all out, otherwise it would be like shooting a bear with a .22 caliber gun… all you’ll do is make him angry.
The following morning I awoke before 5am, unable to sleep. I reviewed Billy’s MRI again and realized the surgical approach I took the first time was probably not ideal to remove the secondary tumor.
And I was right. Taking a different approach allowed me to remove all of the visible tumor I could see under the surgical microscope. I only prayed that I wasn’t so aggressive that I damaged Billy’s ability to speak.
The following day, I found him sitting up in his ICU bed using his computer. He proceeded to tell me that only problem he had was that only very occasionally he would have some difficulty finding the word he wanted to say but was able to use a another, similar word instead.
His postoperative MRI looked quite good. In all I had removed at least if not more than 98% of the tumor that was present on the preoperative scan.
So, looking back you might ask why didn’t a miracle happen. In fact many people seem to believe that only by a miraculous cure can we be certain of God’s goodness. This unfortunately, is a human precondition we try force on God. (This likely was true in the time of Jesus as well!)
I would propose that a miracle did happen; although we really shouldn’t have to see miracles to know that eternal life is much more precious than our imperfect physical lives anyway.
In fact, by getting the diagnosis wrong in the first place caused me use using a different approach during his second operation, which gave Billy a longer time on earth to spend with his wife and family… three years to be exact….
Billy and Donna fought his cancer through radiation and multiple rounds of chemotherapy with remarkable results. However, earlier this year he wound up in the hospital with increasing difficulty speaking.
A follow-up MRI revealed the tumor had finally recurred and had begun to spread to the opposite side of his brain. They were willing to undergo more surgery but I told them that, honestly I didn’t believe it would have a significant impact.
And what was more I told them it would likely damage what remaining ability to speak that he had left.
They decided on another round of chemotherapy, but his condition continued to deteriorate and he passed away several months later… although, and I am certain of this, to a new and everlasting life.
“It is the spirit that gives life, the flesh is of no avail; the words that I have spoken to you are spirit and life.”John 6:63